Does a List of the Top EP's for Ablations Exist? If Not, Why Not?

I have a very popular a-fib blog and one of the most common questions I get asked from people that email me is: how do I find these "expert EP's" you say is so important to find if you're going to have an ablation?

I of course tell them Dr. Natale, but not everyone can fly to Texas or California to be treated by him. I hate telling people that Natale is the only option. He may be the best option, but again, not everyone can be seen by him so I'd like to give them other options. It really bums me out when they tell me Natale isn't an option and I have no other options to give them.

If such a list exists, can someone post it here? If such a list doesn't exist, why not? I wouldn't think it would be that hard to do. There should be at least one top EP for every general region of the U.S. (i.e. Pacific Northwest, West, South, Southeast, East, and Midwest). Natale covers the south and perhaps the West, so that only leaves 4 more EPs to find to start a basic list, right?

Travis

I'm no expert, but if I needed an ablation and I couldn't go to Dr. N, I'd select from the presenters at the annual ISLAA Symposium.

[islaasymposium.com]

Would a presenter automatically be manually skilled? I was once seeking a GI doctor and someone was described to be as an artist with a scalpel. I am copy /,pasting potential EPs from George’s link who are artists with a catheter:

Amin Al-Ahmad, MD
Texas Cardiac Arrhythmia Institute
Austin, TX

Krzysztof Bartus, MD
Jagiellonian University
Krakow, Poland

Jie Cheng, MD
Baylor College of Medicine
Houston, TX

James Cox, MD
Northwestern University
Evanston, IL

Thomas Deering, MD
Piedmont Heart Institute
Atlanta, GA

Luigi Di Biase, MD, PhD
Albert Einstein College of Medicine at Montefiore Hospital
New York, NY

Sephal Doshi, MD
Pacific Heart
Santa Monica, CA

Christopher Ellis, MD
Vanderbilt University
Nashville, TN

Aloke Finn, MD
CV Path Institutue
Gaithersburg, MD

Gregory Fontana, MD
HCA
Thousand Oaks, CA

Jalaj Garg, MD
Loma Linda University
Loma Linda, CA

Rajesh Gopinathannair, MD
Kansas City Heart Rhythm Institute
Overland Park, KS

Edip Gurol, MD
Massachusetts General Hospital
Boston, MA

David R. Holmes Jr. MD
Mayo Clinic
Rochester, MN

Rodney Horton, MD
Texas Cardiac Arrhythmia Institute
Austin, TX

Ken Huber, MD
Saint Luke's Mid America Heart Institute
Kansas City, MO

Chetan Huded, MD
Mid America Heart Institute
Kansas City, MO

Rajesh Kabra, MD
Kansas City Heart Rhythm Institute
Overland Park, KS

Saibal Kar, MD
Los Robles Medical Center
Thousand Oaks, CA

Sheila Kar, MD
Sutter Medical Center
Sacramento, CA

Scott Koerber, MD
Kansas City Heart Rhythm Institute
Overland Park, KS

Subramanyan Krishnan, MD
Smidt Heart Institute at Cedars Sinai Medical Center
Los Angeles, CA

Dhanunjaya Lakkireddy, MD
Kansas City Heart Rhythm Institute
Overland Park, KS

Thorsten Lewalter, MD
University of Bonn
Boon, Germany

Robert Lyons, MD
St. Joseph Mercy
Ann Arbor, MI

Sunil Mankad, MD
Mayo Clinic
Rochester, MN

Moussa Mansour, MD
Massachusetts General Hospital
Boston, MA

Devi Nair, MD
University of Arkansas Medical System
Jonesboro, AR

Andrea Natale, MD
Texas Cardiac Arrhythmia Institute
Austin, TX

Brian O'Neil, MD
Temple University
Philadelphia, PA

Abdi Rasekh, MD
Texas Heart Institute
Houston, TX

Vivek Reddy, MD
Mt Sinai Hospital
New York, NY

Ahmed Romeya, MD
Midwest Heart & Vascular
Overland Park, KS

Jacqueline Saw, MD
Vancouver General Hospital
Vancouver, Canada

Horst Sievert, MD
Cardiovascular Center
Frankfurt, Germany

Lars Sondergaard, MD
Copenhagen University Hospital
Copenhagen, Denmark

Katherine Trivedi, MD
FDA
Washington, DC

David Tschopp, MD
Texas Cardiac Arrhythmia Institute
Austin, TX

Mohit Turagam, MD
Mt. Sinai
New York City, NY

Fantastic Susan!

Thanks Susan!

I'm going to add another doctor to this list:

Pasquale Santangeli, MD, PhD

Maybe we can just keep this thread going with top EP's - or EP's that people have had success with.

Travis

Quote
susan.d
Would a presenter automatically be manually skilled?

You'd need to do more due diligence, but if they are on this list & they are skilled enough (been through a fellowship where this is taught as not all programs do) to be working in and around the LLA, they are in the upper tier, in my book.

Pasquale Santangeli, who is now at Cleveland Clinic, would near the very top of the heap for me, should Andrea Natale not be available to a given Afibber.
A long list like this can be somewhat useful. But the bigger the list then generally the rule of thumb is that the more variable the benefit might be.

Keep in mind your targeted procedural needs and focus on the top handful of Elite operators who essentially do almost only these advanced Ablations at high volume centers.

Dr Santangeli is a truly elite operator in his early prime and yet has had as great of an education as you will likely ever find ...

For many years he mentored under Natale until Natale encouraged him to accept the offer from Frank Marchlinski head of the also elite Univ. of Penn program where Dr. Santangeli mentored for about 7 to 8 years at University of Penn.

Just this past Fall 2022, Dr. Santangeli was awarded a high honor position at Cleveland Clinic that Dr. Natale also encouraged Dr. S. to accept.

I can tell you with strong conviction that these are among the very best EPs you are likely to find.

Take care,
Shannon



Edited 1 time(s). Last edit at 05/30/2023 04:55PM by Shannon.

Posting this because I've been a UMMC CCU patient, so it's in my region -- Dr. Aloke Finn is an interventional cardiologist at University of Maryland Medical Center, not an EP as far as I know. You could certainly contact his office for more info if you're in this area. [www.umms.org]

I personally saw one of these presenters for a consultation and he told me that my case was too complex for him. So not sure if all of these folks are at the same level of expertise - especially in complex cases.

Even the top EP's do not always get the results hoped for - as good as Natale is, he still has his share of do overs.

My last ablation "touch up" number 2 - 4 years ago at CC - which is a high-volume place, has not resolved my afib issue and still on drugs to keep me in rhythm. The EP that did the procedure was not one of the top folks there I later found out. He presents often at various venues and likely has good outcomes with less complex cases. He offered to try again but did not appear to be very eager to do so nor refer me to a colleague.

Complex cases require an EP that likes a challenge and has a history of taking on those types of cases and will share their success record. Finding the right match at these centers is the challenging part. One EP I am interviewing read my case records and told me that the last EP did not complete the circuit because how close it was to the phrenic nerve. He told me what he would do to mitigate the risk for that area if that is where the issue is. I won't go into the details of his technique, but it gave me confidence. Also mentioned that the Pulsed field ablation would be safer for me given the location of where he believes where the issue is. Also, the technology and mapping has improved in the last 4 years.

It seems to me that many of the failures of first RF ablation, and a touchup that follows, has to do with where they get to with the lesions and where they run out of security, for want of a better word. Each physician has their limit, and they know what it is if they are people of integrity and courage. If they get to lesion #58, and it is starting to look like they're likely to dramatically increase the risk to the patient with any further moves to the left/right, they know they must stop and hope the curing process where lesions close up and heal against each other might be sufficient. Clearly, in maybe 15% of all cases, it isn't. And it really isn't their fault, especially if they have no experience or training in going beyond the routine PVI.

And, yes, even the highly regarded Dr. Andrea Natale has to back off at some point so as not to endanger a critical component of the heart's physiology, or of something proximal to the area where he runs out of room. And if that is precisely where the spurious signal will continue to make the heart to a jig, he will have failed. The probability of success remains with the most experienced and highly trained EPs. When they have played their best card and been trumped.............

I would say you also missed Dr. Pierre Jais and Dr. Melize Hocini in Pessac (Bordeaux) France. In my books, they’re easily as good as Natalie.

Monty

I'd add:-

[www.massgeneral.org]

He did my PVI ablation a dozen or so years ago at Mass General